A Volatile Mix?

By GEORGINA GUSTIN

Published: March 16, 2003

THE fire at the Greenwood Health Center, a 150-bed nursing home near Hartford's downtown, that killed 13 people and injured 20 on Feb. 26 was the most lethal fire in an American nursing home in more than a decade and the worst in a Connecticut health care facility since a fire at Hartford Hospital killed 16 in 1963.

The primary suspect in the fire is Lesley Andino, a 23-year-old Hartford woman who has multiple sclerosis and a history of drug abuse. Her possible role in starting the fire has fueled the debate over who should and who shouldn't be allowed to live in the state's nursing homes.

''Putting people with psychiatric problems in homes when they're a danger to themselves or to others just can't continue,'' said State Senator Edith G. Prague, chairwoman of the General Assembly's Select Committee on Aging. ''People suffering from psychiatric illnesses who behave erratically, there's no way they should be interspersed with the frail elderly.''

Some state officials and advocates for the elderly are wondering why Ms. Andino, who has a history of emotional problems, was placed in a room with Lois Morin, a partly paralyzed 72-year-old woman, who died in the fire.

Less than a week after the fire, Ms. Prague presided over a public hearing to discuss a bill she proposed earlier this year that would separate the mentally ill from the elderly in nursing homes. At the hearing, Ms. Morin's son, William, said he was not pleased about his mother's roommate.

''That mix shouldn't have happened,'' he said. ''My mother was put into a situation she couldn't get out of. My mother was incapacitated.''

Mr. Morin said he was never told about Ms. Andino's problems, but in hindsight said he saw trouble coming. ''There were situations that led to this,'' he said, saying she had behaved erratically when he visited his mother the night before the fire.

Dianne Casey, whose mother has lived at Greenwood for two years, said the mentally ill should not be paired with the elderly.

"Did she do it on purpose? That's not the issue," Ms. Casey said, referring to Ms. Andino. "It was established she was mentally ill. She never should have been there.''

The problem, some said, is that there is often no place else to put the mentally ill and they end up in nursing homes.

''People are being put into nursing homes as a substitute for care,'' said Janet Wells, the director of public policy for the National Coalition for Nursing Home Reform, adding, ''There is clearly a need to address the problem.''

People in the mental health community said that there is indeed a problem, but mentally ill patients should not be made the scapegoats. Mental health workers stressed that the legislation will stigmatize the mentally ill and questioned how the bill would define mental illness, a term that encompasses everything from schizophrenia to depression.

Most people who end up in nursing homes come from hospitals after being treated for serious illnesses or injuries, conditions that often lead to depression

''In general, people who have serious physical illnesses sometimes become despondent over their illness,'' said Wayne Dailey, a spokesman for the State Department of Mental Health and Addiction Services. ''It's common.''

That means, Mr. Dailey said, that depression, which is considered a mental illness, could hypothetically be a reason for many people to be singled out.

Where, mental health advocates wonder, will the law draw the line?

''It's really a misrepresentation of facts to suggest that risky behavior in nursing homes is the exclusive province of people with mental illnesses,'' Mr. Dailey said. ''This is far from the case. Most people with mental illnesses in nursing homes are very stable and indistinguishable from other patients.''

Citing a study by the Connecticut group, the Violence in Nursing Homes Study Group, mental health advocates said the mentally ill are no more or less dangerous to residents than other nursing home residents with Alzheimer's or dementia, who do not fall under the federal definition of mental illness but are potentially as dangerous.

''It feeds into the stereotype that people with mental illness are more violent,'' said Jan Van Tassel, the executive director of the Connecticut Legal Rights Project, referring to the legislation.

''There seems to be an immediate knee-jerk reaction to associate this with mental illness, and in this instance it doesn't appear to me this person had a major psychiatric diagnosis. Certainly there was physical illness and addiction.''

Ms. Van Tassel noted that the 21st amendment of the state's Constitution identified people with physical and psychiatric disorders as protected classes. ''I believe this is unconstitutional,'' she said.

Others agreed. ''The citizens treated and cared for by my agency on behalf of the State of Connecticut must have the same legal, ethical and basic rights to the full range of health care services and settings as does any other citizen, and that included access to care provided at a nursing home,'' said the state's mental health commissioner, Thomas Kirk, addressing the public hearing. ''The Department of Mental Health and Addiction Services cannot support any legislation that restricts that right.''